Internal Medicine Coding Alert

These new ICD-9 codes round out your migraine coding smarts.

You can provide unprecedented specificity using five new codes in the 346.xx code set if you have the inside scoop on the terms and symptoms that comprise this group. Read about the brand-new migraine diagnosis codes with the five following capsule summaries:

The first new preliminary code ICD-9 2009 adds to the series is 346.3x (Hemiplegic migraine). Providers consider this rare migraine type one of the more severe forms. Symptoms include temporary paralysis -- hemiplegia -- or sensory changes on one side of the body, as well as dizziness or vision changes.

This classification encompasses both familial and sporadic migraines, said Stephen D. Silberstein, MD, FACP, past president of the American Headache Society, director of the Jefferson Headache Center, and professor at Thomas Jefferson University Hospital in Philadelphia, in his presentation, "Headache Classification 2007" (http://www.cdc.gov/nchs/ppt/icd9/att1_headache_mar07.ppt).

New coding subcategory 346.4x (Menstrual migraine) covers menstrually related migraines and pure menstrual migraines, Silberstein said.

New ICD-9 code 346.5x (Persistent migraine aura without cerebral infarction) will give you several new options when coding for persistent migraines. "Remember, these codes indicate persistent migraine aura, not persistent migraine," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver.

According to the International Headache Society, "persistent migraine aura is one or more aura symptoms persisting for more than one week." The symptoms are those of a migrainous visual aura that either recurs repetitively hour-after-hour, day-after-day for weeks, months, or years, or does not abate for weeks, months, or years.

Following 346.5x -- which you'll use for patients with persistent migraine aura without cerebral infarction -- is its opposite, 346.6x (Persistent migraine aura with cerebral infarction).

Lesson learned: Be sure to watch for "cerebral infarction" in the physician's documentation so you can choose the most appropriate code.

New code 346.7x (Chronic migraine without aura) brings a variety of new coding possibilities for chronic migraines.

Experts note: You should use this coding subcategory to describe transformed migraines (TM), Silberstein said. The TM term is just another way to describe chronic migraines, Hammer says.

What it is: A TM is a migraine that started with episodic migraine attacks. These attacks then increase in frequency and change characteristics, resulting in less severe headaches on an almost daily basis that are punctuated by severe and debilitating migraine attacks.

Use the 346.7x codes "when the migraine occurs on more days than not for greater than three months in the absence of medication overuse," Hammer says.

So if a patient reports suffering migraines at least 18 times a month since January, for example, you'd use a TM (chronic migraine) code.